Motor vehicle transportation in hip spica casts: are our patients safely restrained?

BACKGROUND Federal guidelines and state laws mandate that all children must be appropriately restrained while traveling in motor vehicles to reduce the risk of injury and death secondary to motor vehicle accidents. The purpose of this study is to identify the methods of restraint in motor vehicles for children in hip spica casts. METHODS Children placed in hip spica casts between August 1, 2006 and August 1, 2008 were recruited. Demographic data, type of spica cast placed, and reason for cast placement were recorded. Before discharge, all children were evaluated by a physical therapist to determine adequate restraint with the least cost. At each follow-up visit and at the time of cast removal, parents filled out standardized nonvalidated questionnaires to determine the method of restraint, mode of transportation, the approximate number of trips taken per week, and the occurrence of traffic violations or accidents. RESULTS Thirty-one children, average age of 5 years (range, 1.3 to 13 y), in a total of 35 spica casts were enrolled in the study. After evaluation by the physical therapist, none of the children were recommended to be transported in their personal car seat, 12 children were advised to travel by ambulance and 23 were advised to use a specially manufactured car seat. Overall, 8 of 35 children (23%) followed the initial recommendation of the physical therapist. On the basis of our discharge protocol's recommendations, children in 24 spica casts (69%) were suboptimally transported after discharge, 6 children who should have had ambulance transportation and 18 who should have been transported by a specially manufactured car seat. CONCLUSIONS The majority of children in hip spica casts are not safely restrained when traveling in motor vehicles. Pediatric hospitals must develop better strategies to improve adherence to prescribed safe transportation protocols for patients in hip spica casts. Improved parental education, expansion of insurance coverage for restraints, hospital-based loaner programs and financial assistance to families are potential solutions to explore.